Rare bleeding complication of the radial artery conduit after coronary artery bypass grafting with endoscopic harvesting.

A 79-year-old man with unstable angina developed localized left atrial tamponade after conventional coronary artery bypass grafting (CABG) with endoscopic radial artery harvesting (ERAH). Hemodynamic instability developed several hours after the systemic heparinization. Transthoracic and later intraoperative transesophageal echocardiography revealed a large, isolated hematoma compressing the left atrium. The radial artery for the circumflex artery bled during an emergent re-sternotomy. Incomplete hemostasis of the radial artery by ERAH was the likely cause of this serious complication. Surgeons, especially those who are new to ERAH, should examine the harvested radial arterial conduit carefully and confirm complete hemostasis before performing the procedure.